Psychiatric comorbidity, behavioral predictors, and orthopedic outcomes in patients with metacarpal neck (boxer's) fracture: A single-center retrospective cohort study

Metacarpal neck (boxer's) fractures frequently result from direct trauma and may indicate underlying psychiatric or behavioral conditions. The impact of psychiatric comorbidity on treatment adherence and orthopedic outcomes remains underexplored. To evaluate the prevalence of psychiatric disorders in patients with boxer's fractures and their association with treatment compliance, recurrent injuries, and functional outcomes. This retrospective cohort study included 394 patients treated at Erzurum City Hospital Orthopedics Clinic between January 2020 and August 2024. Psychiatric diagnoses were classified per DSM-5 criteria. Primary outcomes were recurrent fracture and treatment compliance; secondary outcomes included complications, functional scores (DASH, grip strength, range of motion), and time to return to activity. Multivariable logistic and proportional odds regression models adjusted for confounders. Propensity score analysis with inverse probability of treatment weighting (IPTW) addressed confounding by indication in surgical versus conservative treatment comparisons. Psychiatric disorders were present in 46.4 % of patients, with anxiety (24.4 %), depressive (18.5 %), and impulse-control disorders (12.2 %) most common. Psychiatric comorbidity (≥2 disorders) was found in 53 % of diagnosed patients. After adjustment, psychiatric diagnosis was independently associated with recurrent fracture (adjusted OR 1.78, 95 % CI 0.98–3.24, p = 0.059), poor treatment compliance (adjusted OR 2.65, 95 % CI 1.38–5.10, p = 0.003), and worse overall outcome (adjusted OR 0.34, 95 % CI 0.23–0.52, p < 0.001). Patients with psychiatric diagnoses had significantly higher DASH scores, longer return to activity, and lower satisfaction. History of aggression strongly predicted recurrent fracture (adjusted OR 3.13, 95 % CI 1.77–5.52, p < 0.001). IPTW-adjusted analysis showed no significant outcome differences between surgical and conservative treatments. Nearly half of patients with boxer's fractures have psychiatric comorbidities, which independently predict poor treatment adherence, recurrent injuries, and inferior functional outcomes. Integrating psychiatric screening and behavioral risk assessment into fracture management is essential to optimize patient care.